Login
Site Search
Trauma-List Subscription

Subscribe

Would you like to receive list emails batched into one daily digest?
No Yes
Modify Your Subscription

Modify

Home > List Archives

Clamp the the chest tube?

docrickfry at aol.com docrickfry at aol.com
Sun Apr 9 21:00:38 BST 2006


In that case you in New York are quite out of touch with the current published standards--see PHTLS and Norm McSwain's Scudder Oration in Truama from 3 years ago--although there is room for a variety of prehospital interventions, none of these should ever delay the rapid transport of a patient to the nearest appropriate hospital, which remains the most important principle of prehospital trauma management.  There is no place for any time in the field for an injured patient except extrication
ERF 
 
-----Original Message-----
From: J.A. Terranson <measl at mfn.org>
To: Trauma &amp; Critical Care mailing list <trauma-list at trauma.org>
Sent: Sun, 9 Apr 2006 14:14:59 -0500 (CDT)
Subject: Re: Clamp the the chest tube?



On Sat, 8 Apr 2006 docrickfry at aol.com wrote:

> Please refresh--when did we ever leave it?

While i can't speak to your neck of the woods, in New York we left this
behind in the late '80s.  In fact, until the NYFD borged our EMS, our
EMT-Ps (and often our "EMTPYs" [awful emts] were pretty close to actually
practicing independent medicine.  Where are *you* that scoop and run is
still the norm?


> ERF
>
> -----Original Message-----
> From: J.A. Terranson <measl at mfn.org>
> To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
> Sent: Sat, 8 Apr 2006 12:56:50 -0500 (CDT)
> Subject: Re: Clamp the the chest tube?
>
>
>
> So, are you proposing we go back to "Scoop and Run"?
>
>
> On Sat, 8 Apr 2006 docrickfry at aol.com wrote:
>
> > Ahhhh...this argument always manages to rear its ugly head at some
> > point-- "Well, you know, evidence is fine, data-based medicine is fine,
> > until, that is, that is fails to support something that I just want to
> > do--then....MY own imagination and what I think sounds logical prevails"
> > Remember just 250 years ago this same argument was used for
> > bloodletting--perfectly logical to everybody, lets out the evil humors,
> > plenty of anecdotal cases of how people suddenly felt better, etc--who
> > needs data for such OBVIOUSLY beneficial intervention?  Then the data
> > came out, and guess what--not only no benefit, but it KILLED!  Same with
> > electro-shock Rx, frontal lobotomy--without a QA process applied, any
> > interventio is DANGEROUS until PROVEN otherwisw--why?  Because THAT, not
> > the opposite, is what is SAFEST for the patient. And we think witch
> > doctors were only a thing of the past..... ERF
> >
> > -----Original Message-----
> > From: Mike MacKinnon <mmackinnon at cox.net>
> > To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
> > Sent: Fri, 7 Apr 2006 20:25:42 -0700
> > Subject: Re: Clamp the the chest tube?
> >
> >
> > Hey Dr. KM
> >
> >
> >
> > No data to my knowledge. However, just because something hasn't been studied
> > doesn't mean it has no empirical benefit (i.e.: the classic parachute
> > example).
> >
> >
> >
> > The procedure is utilized in air med for the same reasons (more stringent I
> > would suggest) as in the trauma room. Patient in extremis with clear chest
> > tube indication and long transport times. I can tell you, no more than 1-2
> > of these are done a year at my service and everything done is reviewed by
> > our 4 med directors and the receiving trauma surgeon. While there is no data
> >  I would suggest that with those two groups in agreement that the patient
> > needed a chest tube and it was justified that there is oversight and control
> > in regards to such a high risk procedure.
> >
> >
> >
> > Really, are you suggesting you need a peer reviewed study to show indication
> > for a procedure that is a "no brainer" and clinically driven in the trauma
> > room? The indications for air med are few and far between for chest tubes
> > (much less than in the trauma room).
> >
> >
> >
> > In anycase, here are three studies which I found after a quick search.
> >
> >
> >
> > Prehosp Emerg Care. 2005 Apr-Jun;9(2):191-7.
> >
> >
> >
> >
> >
> > The safety and efficacy of prehospital needle and tube thoracostomy by
> > aeromedical personnel.
> >
> >
> >
> > Davis DP, Pettit K, Rom CD, Poste JC, Sise MJ, Hoyt DB, Vilke GM.
> >
> >
> >
> > Department of Emergency Medicine, UCSD, San Diego, CA 92103, USA.
> > davismd at cox.net
> >
> >
> >
> > BACKGROUND: Aeromedical crews routinely use needle thoracostomy (NT) and
> > tube thoracostomy (TT) to treat major trauma victims (MTVs) with potential
> > tension pneumothorax; however, the efficacy of prehospital NT and TT is
> > unclear. OBJECTIVES: To explore the efficacy of aeromedical NT and TT in
> > MTVs. METHODS: A retrospective chart review was performed using prehospital
> > medical records and the county trauma registry over a seven-year period. All
> > MTVs undergoing placement of NT or TT by aeromedical personnel were included
> >  patients with incomplete data were excluded. Descriptive statistics were
> > used to report the incidence of air release, clinical improvement (improved
> > breath sounds or compliance if intubated, decreased dyspnea if nonintubated)
> >  and vital signs improvements (systolic blood pressure [SBP] increase to =90
> > mm Hg or increase by 5 mm Hg if < 90 mm Hg; heart rate improvement to 60-100
> > beats/min, increase by 10 beats/min if < 60 BPM, or decrease by 10 beats/min
> > if > 100 beats/min; oxygen saturation increase if < 95%) for both NT and TT
> > as documented in prehospital medical records. Survival and improvement in
> > SBP based on trauma registry data were recorded for patients stratified by
> > initial SBP. RESULTS: A total of 136 procedures (89 NTs and 47 TTs) in 81
> > patients were identified using prehospital medical records over a four-year
> > period. Response rates to NT (60% overall, 32% vital signs) and TT (75%
> > overall, 60% vital signs) were high. Vital signs improvements were observed
> > more often in patients with a pulse and in nonintubated patients. A total of
> > 168 patients were identified in the trauma registry over the seven-year
> > study period. Normalization of SBP was observed in two-thirds of patients
> > with a field SBP = 90 mm Hg and one-third of patients in whom field SBP
> > could not be obtained. A small but significant proportion of patients
> > undergoing prehospital NT and TT, including some with prehospital
> > hypotension and high injury severity, survived to hospital discharge. The
> > incidence of complications was low. CONCLUSIONS: Aeromedical crews appear to
> > appropriately select MTVs to undergo field NT or TT. A low incidence of
> > complications and a small but significant group of unexpected survivors
> > support continued use of this procedure by aeromedical personnel.
> >
> >
> >
> > J Emerg Med. 1995 Mar-Apr;13(2):155-63.
> >
> >
> >
> >
> >
> > Prehospital needle aspiration and tube thoracostomy in trauma victims: a
> > six-year experience with aeromedical crews.
> >
> >
> >
> > Barton ED, Epperson M, Hoyt DB, Fortlage D, Rosen P.
> >
> >
> >
> > Department of Emergency Medicine, University of California, San Diego
> > Medical Center 92013-8676, USA.
> >
> >
> >
> > The use of prehospital tube thoracostomy (TT) for the treatment of suspected
> > tension pneumothorax (TPtx) in trauma patients is controversial. A study is
> > presented that reviews a 6-year experience with the use of needle catheter
> > aspiration (NA) and chest tubes performed in the field by air medical
> > personnel. Prehospital flight charts and hospital records from 207 trauma
> > patients who underwent one or both of these procedures in the field were
> > retrospectively reviewed. The clinical indications used to determine
> > treatment are presented for both procedures. Improvement in clinical status
> > of patients observed by flight personnel were similar for both treatment
> > groups (54% for NA, 61% for TT). Thirty-two (38%) of the TT patients had
> > failed NA attempts prior to chest tube placement. Average time on scene (T.O
> > S.) was significantly greater for the TT group (25.7 min versus 20.3 min for
> > NA group). Fewer patients were pronounced dead on arrival (D.O.A.) with TT
> > treatment compared to NA alone (7% versus 19%, respectively). Injury
> > severity scores, number of hospital complications, length of stay (L.O.S.),
> > and total hospital costs were not different between the two groups. There
> > were no cases of lung damage or empyema formation associated with
> > prehospital TT treatment. Overall mortality was similar for both groups.
> > >From these data, we conclude that NA is a relatively rapid intervention in
> > the treatment of suspected TPtx in the prehospital setting; however, TT is
> > an effective adjunct for definitive care without increasing morbidity or
> > mortality. A better understanding of the physiology of intrapleural air
> > masses is needed to determine the most effective decompression requirements
> > prior to aeromedical transport.
> >
> >
> >
> > J Trauma. 2005 Jul;59(1):96-101.
> >
> >
> >
> > Prehospital chest tube thoracostomy: effective treatment or additional
> > trauma?
> >
> >
> >
> > Spanjersberg WR, Ringburg AN, Bergs EA, Krijen P, Schipper IB.
> >
> >
> >
> > Department of General Surgery and Traumatology, University of Rotterdam,
> > Erasmus Medical Center, The Netherlands.
> >
> >
> >
> > BACKGROUND: The use of prehospital chest tube thoracostomy (TT) remains
> > controversial because of presumed increased complication risks. This study
> > analyzed infectious complication rates for physician-performed prehospital
> > and emergency department (ED) TT. METHODS: Over a 40-month period, all
> > consecutive trauma patients with TT performed by the flight physician at the
> > accident scene were compared with all patients with TT performed in the
> > emergency department. Bacterial cultures, blood samples, and thoracic
> > radiographs were reviewed for TT-related infections. RESULTS: Twenty-two
> > patients received prehospital TTs and 101 patients received ED TTs. Infected
> > hemithoraces related to TTs were found in 9% of those performed in the
> > prehospital setting and 12% of ED-performed TTs (not significant).
> > CONCLUSION: The prehospital chest tube thoracostomy is a safe and lifesaving
> > intervention, providing added value to prehospital trauma care when
> > performed by a qualified physician. The infection rate for prehospital TT
> > does not differ from ED TT.
> >
> >
> >
> > Mike M.
> >
> >
> >
> > -------Original Message-------
> >
> >
> >
> > From: KMATTOX at aol.com
> >
> > Date: 04/07/06 20:02:20
> >
> > To: trauma-list at trauma.org
> >
> > Subject: Re: Clamp the the chest tube?
> >
> >
> >
> >
> >
> > In a message dated 4/7/2006 10:00:15 P.M. Central Standard Time,
> >
> > mmackinnon at cox.net writes:
> >
> >
> >
> >
> >
> > Happens all the time Dr. Mattox. Long transport times where  patients are
> >
> > severly injured and need a completely justifiable chest  tube.
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > True true and unrelated.    Show me the  data.   I know of no good data
> > which
> >
> > has been peer reviewed by the  Trauma service in critique of flight services
> >
> >
> >   Flight services  procedures are among the most out of control of any in
> >
> > medicine.
> >
> >
> >
> > k
> >
> > --
> >
> > trauma-list : TRAUMA.ORG
> >
> > To change your settings or unsubscribe visit:
> >
> > http://www.trauma.org/traumalist.html
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/traumalist.html
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/traumalist.html
> >
>
>

-- 
Yours,

J.A. Terranson
sysadmin at mfn.org
0xBD4A95BF


'The right of self defence is the first law of nature: in most governments
it has been the study of rulers to confine this right within the narrowest
limits possible. Wherever standing armies are kept up, and the right of
the people to keep and bear arms is, under any colour or pretext
whatsoever, prohibited, liberty, if not already annihilated, is on the
brink of destruction.'

St. George Tucker
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/traumalist.html


More information about the trauma-list mailing list